Mississippi Today

Experts say Gov. Tate Reeves’ plan will help hospitals, but not uninsured Mississippians

Published

2 years ago

September 25, 2023

Gov. Tate Reeves, after months of inaction, has unveiled a plan he says will turn Mississippi’s health care crisis around.

However, even some health care experts were stumped by how the Governor’s proposed reforms will work.

The plan, which Reeves announced at a press conference Thursday while flanked by state health care leaders, is essentially a complex scheme to increase extra payments hospitals get for treating patients on Medicaid — and notably doesn’t include Medicaid expansion.

Some Mississippi leaders say Reeves’ ideas aren’t even that new. It’s not certain they’ll be approved, either.

The announcement comes less than two months before Election Day, and after his opponent in the gubernatorial race, Democrat Brandon Presley, has repeatedly stated his intention to expand Medicaid if elected and largely campaigned on the state’s hospital crisis.

Two things were clear at the conference: Reeves claims the changes would put a much-needed $700 million in hospitals’ pockets, and he does not plan to expand Medicaid.

Everything else, however, was not as easy to understand.

How will Gov. Reeves’ plan work?

The plan relies on two major changes that bolster supplemental payments to hospitals for the care they provide to people with Medicaid. Supplemental payments are extra payments hospitals receive to offset low Medicaid reimbursement rates or uncompensated care, which is money hospitals lose caring for patients who are uninsured and can’t pay their hospital bill. Medicaid is a federal-state program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. The income requirement for people in Mississippi to qualify is extremely stringent.

The first is a change to the Mississippi Hospital Access Program, which typically pays hospitals for the gap between payments for services rendered for Medicaid managed care patients (which are usually lower) and Medicare patients (which are usually slightly higher). Under the proposed changes, hospitals will instead be paid for the gap between Medicaid patients and people insured by commercial plans, which tend to reimburse at higher rates.

The state Division of Medicaid was granted a similar change to the program in March for outpatient services, resulting in $40.2 million for hospitals. However, Medicaid officials had expected it to generate an additional $450 million. But because Mississippi’s average commercial rate is so low, the payout was much less.

What’s not clear is how, in Reeves’ plan, the average commercial rate results in nearly triple what hospitals typically get for these payments — going from a total of $562 million to $1.522 billion. Reeves didn’t say at the press conference what average commercial rate was actually being used (whether a state, regional or national rate).

Drew Snyder, Mississippi Division of Medicaid executive director, answers questions from the media after Gov. Tate Reeves announced his plans for a series of Medicaid reimbursement reforms during a press conference at the Walter Sillers Building in Jackson, Miss., on Thursday, September 21, 2023. Credit: Eric Shelton/Mississippi Today

When asked what had changed since the spring regarding these rates, Medicaid Executive Director Drew Snyder did not directly answer the question.

“I think the difference is, we got the right people in the room … sometimes it makes sense to get a second opinion,” he said before stepping back in line on stage.

The second initiative modifies the Upper Payment Limit Supplemental Payments, which are aimed at also increasing payments for hospitals that receive low payments from Medicaid. This program will yield an increase of an additional $137 million in fiscal year 2024, according to Reeves.

State leaders did something similar earlier this year after the Mississippi Hospital Access Program projections came in much lower than originally expected, said Tim Moore, former leader of the state hospital association. It resulted in an extra one-time payment of $137 million.

The supplemental payment programs are meant to reduce disparities in insurance payments and the cost of caring for uninsured people. By changing them, the state is drawing down more federal money because of our state’s high Federal Medical Assistance Percentage match, which is the highest in the country at 77.27% because of our state’s high poverty rate. Hospitals have to put up more in “bed taxes” for the state portion, and then the federal government matches.

In other words, if a Medicaid patient receives a service at a Mississippi hospital that costs $100, the hospital is reimbursed $77.27 from federal funds. The remaining $22.73 must be paid by the state – that $22.73 comes from the hospitals themselves in the form of a tax.

Harold Miller, leader of the Center for Healthcare Quality and Payment Reform described it this way: “When the state is paying for a Medicaid service, the state has to find the state share — that 23% — somewhere. They have to find that money, and ordinarily they would have to tax the taxpayers to do that.” Instead, Mississippi asks the hospitals for that money, he said.

In short, hospitals will have to pay $178 million in taxes for Mississippi Hospital Access Program payments to go up by $960 million, Upper Payment Limit payments will yield $137 million and disproportionate share hospital payments — which make up the difference for hospitals that lose money on serving a significant population of Medicaid-insured and uninsured people — will decrease by $230 million because the other payments are bridging the gap. The net gain for hospitals will be $689 million total.

Who will the plan help?

Experts agree this plan will keep hospitals open for longer. Even if it’s unclear how the expected payments will increase, it’s still a significant amount of money — money that hospitals have been asking for for a long time. However, critics say it’s not ensuring more people receive health care.

According to federal data, Mississippi has the highest uninsured rate of people aged 18-64 in the country, as of September. About one in every six Mississippians is uninsured.

Emergency rooms by law cannot turn down people, regardless of their insurance status, who come for care — but doctors’ offices can and so can pharmacies. That means people who are uninsured in Mississippi, one of the unhealthiest states in the nation, cannot receive preventative care or medications that they need. They generally must rely on the emergency room for their health care needs.

“People typically need a lot more care than care in a hospital, and a lot of that care is preventive care… outpatient care,” said Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid. “If you get cancer and you need prescriptions and drugs and outpatient care from a team of specialists, this has nothing to do with that. So, the key differences, this is an issue about the finances of hospitals.

“And Medicaid expansion is about financial security for families.”

How much money is it bringing to hospitals?

Reeves said a little over $689 million will go to the state’s hospitals under this plan.

And although he said Thursday the money would benefit all hospitals, it appears larger hospitals will benefit most, even though most agree that small rural hospitals are the facilities feeling the strain of the health care crisis most acutely.

Additionally, nearly half of the money — 45% or about $309 million — will go to hospitals that have left the state hospital association in recent months. In the spring, after the Mississippi Hospital Association’s PAC made a $250,000 donation to Presley, several hospitals left the organization.

Most of those hospitals’ leaders stood behind Reeves as he announced his plan Thursday.

Is this a new plan?

Reeves said at the press conference this plan has been in the works for four to five months.

According to Tim Moore, former head of the state hospital association, and another state leader, that’s not true.

A year ago, Moore learned of similar measures in Louisiana and brought the idea to state leaders. Lt. Governor Delbert Hosemann recently told Mississippi Today that hospital payment initiatives were discussed by stakeholders last year, but the Division of Medicaid told his office that those changes weren’t possible.

Will it cost the taxpayers anything?

Reeves repeated at the conference that the changes would come at no cost to taxpayers, though he noted Snyder and his division employees are paid by state tax dollars.

That’s mostly true — taxpayers will likely not feel the brunt of this big tax increase for hospitals, according to one expert. Even if hospital charges increase, it should be eaten by the insurance companies and services for people who are uninsured will continue to go uncompensated and be claimed as charity care.

Is it final?

The plan is being submitted to the Centers for Medicaid and Medicare Services for approval. Snyder estimated at the conference that the state would likely hear from the federal government within two to three months. If it’s approved, it would be retroactively effective beginning July 1, 2023.

It’s hard to say what the likelihood of approval is, though several other states have passed similar Medicaid reforms intended to draw down more federal dollars.

One expert said it was unlikely that Mississippi state leaders announced the plan without expecting CMS approval, and historically, the agency has erred on the side of keeping hospitals open — even if it comes at the cost of forgoing expansion.

How is this different from Medicaid expansion?

Medicaid expansion has long been pointed to as a solution to the state’s worsening hospital crisis. Republican state leadership – Reeves most prominently – has staunchly opposed the policy adoption, despite support from a majority of Mississippians.

At the press conference Thursday, Reeves repeatedly incorrectly referred to the program as “welfare,” and claimed the solution to the issue was putting more people in the workforce. He said if more people are added to Medicaid’s rolls, hospitals will keep losing money because Medicaid payments are so low.

That’s better than losing money on people who are uninsured, said Adam Searing, the associate professor whose work focuses on Medicaid.

“These are two disconnected things,” he said. “Reimbursement rates for hospitals and expanding Medicaid are completely separate issues.”

While hospital leaders agree that these policy reforms will make a huge difference for many hospitals in the state, it still might not be enough to single handedly solve the crisis. In other states, such as Louisiana, similar policy reforms work in tandem with Medicaid expansion to create a holistically supported health care system.

The way Moore sees it, the state is putting up $170 million for a $700 million net gain, when with expansion, it could put up $100 million for a $1 billion reward.

States that have not expanded Medicaid have been offered a financial incentive to do so — an estimated $600 million in federal funds over two years.

And, despite more hospitals that will probably be able to stay open as a result of these reforms, uninsured Mississippians still won’t have health care. That means they will have to continue to rely on emergency rooms for their medical care — the most expensive place to receive health care — and uncompensated care costs will continue.

Searing said these reforms “improve the financial bottom line for some hospitals” and keep them open longer, but people are still going without health coverage.

“You’re really not solving the problem,” he said. “You’re just putting a Band-Aid on one aspect of it.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1850, Shadrach Minkins escaped from slavery

Published

22 hours ago

May 3, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-05-03 07:00:00

by Jerry Mitchell, Mississippi Today
May 3, 2025

May 3, 1850

Shadrach Minkins, right, worked at the Cornhill Coffee House and Tavern, believed to have been located in the highlighted area.

Shadrach Minkins, already separated from his family, escaped from the Norfolk, Virginia, home, where he was enslaved. He made his way to Boston, where he did odd jobs until he began working as a waiter at Taft’s Cornhill Coffee House.

Months later, Congress passed the Fugitive Slave Act, which gave authorities the power to go into free states and arrest Black Americans who had escaped slavery.

A slave catcher named John Caphart arrived in Boston with papers for Minkins. While serving breakfast at the coffee house, federal authorities arrested Minkins.

Several local lawyers, including Robert Morris, volunteered to represent him. Three days later, a group of abolitionists, led by African-American abolitionist Lewis Hayden, broke into the Boston courthouse and rescued a surprised Minkins.

“The rescuers headed north along Court Street, 200 or more following like the tail of a comet,” author Gary Collison wrote. They guided him across the Charles River to the Cambridge home of the Rev. Joseph C. Lovejoy, whose brother, Elijah, had been lynched by a pro-slavery mob in Illinois in 1837.

Another Black leader, John J. Smith, helped Minkins get a wagon with horses, and from Cambridge, Hayden, Smith and Minkins traveled to Concord, where Minkins stayed with the Bigelow family, which guided him to the Underground Railroad, making his way to Montreal, spending the rest of his life in Canada as a free man.

Abolitionists cheered his escape, and President Millard Fillmore fumed. Morris, Hayden and others were charged, but sympathetic juries acquitted them. Meanwhile in Montreal, Minkins met fellow fugitives, married, had four children and continued to work as a waiter before operating his own restaurants.

He ended his career running a barbershop before dying in 1875. A play performed in Boston in 2016 told the dramatic story of his escape.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post On this day in 1850, Shadrach Minkins escaped from slavery appeared first on mississippitoday.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Centrist

The article presents a historical recount of Shadrach Minkins’ escape from slavery and the role abolitionists played in his rescue. The content is fact-based, focusing on a historical event without promoting a particular ideological stance. While it centers on the abolitionist movement and highlights the moral victory of Minkins’ escape, it does so in a narrative style rather than advocating for any contemporary political agenda. The tone is neutral, and the article adheres to factual recounting of historical events, making it centrist in its approach to the subject matter.

Mississippi Today

Ghost town of Orwood residents provide lessons for today by working with scientists in 1800s to combat yellow fever

Published

2 days ago

May 2, 2025

Staff Editor

mississippitoday.org – @BobbyHarrison9 – 2025-05-02 09:36:00

by Shirley Wimbish Gray, Mississippi Today
May 2, 2025

Editor’s note: This essay is part of Mississippi Today Ideas, a platform for thoughtful Mississippians to share fact-based ideas about our state’s past, present and future. You can read more about the section here.

Given recent policy changes threatening the future of medical research and news of Mississippi’s falling childhood vaccination rates, I fear we are ignoring lessons learned the hard way.

One of those lessons occurred during a yellow fever outbreak in the summer of 1898 when a community of honest citizens in Orwood, then a hamlet in southwest Lafayette County, helped a team of physicians change the direction of public health for Mississippi and the rest of the country.

I first heard about their story listening to a documentary about yellow fever with my husband, a virologist, who teaches at the University of Mississippi. The video mentioned an unnamed doctor in Mississippi who had advanced a theory linking mosquitoes and yellow fever.

The story I uncovered models the honesty and trust in medical science we need today to keep our families and communities healthy.

***

Yellow fever was a problem in the South throughout the 1800s. Its initial symptoms — fever, body aches and severe headache — were followed by jaundice and in some cases internal bleeding leading to death. The jaundice left the skin tinged with yellow, thus the name “yellow fever.”

Shirley Gray

In early August 1898, a young woman named Sallie Wilson Gray (no relation to the author) developed chills and a fever while visiting at her uncle’s home in Taylor. Her uncle immediately sent her home to be cared for by her family in Orwood, about 10 miles away.

Days later, Sallie’s uncle in Taylor died from what proved to be yellow fever. Family members wiped black vomit, a sign of internal bleeding, from his body as he lay in his coffin.

Sallie had now brought the same illness home to Orwood.

***

I learned about yellow fever in seventh grade when we studied the 1878 yellow fever epidemic, the worst to strike the Mississippi River Valley. That year, Mississippi reported almost 17,000 cases and more than 4,000 deaths. I didn’t realize, though, how yellow fever continued to appear year after year.

Physicians had a basic understanding of bacteria after the Civil War, but they didn’t recognize viruses, which proved to be the cause of yellow fever, until later in the 1900s. One popular theory suggested yellow fever spread on fomites—inanimate surfaces—like bedding, clothing and furniture. Panic often followed news of a yellow fever outbreak. Health officials established quarantines, closed roads, river ports and train stations, hoping to curb the spread of infections.

The fear of what was not known then about yellow fever reminded me of the early days of the COVID pandemic when fear spread through rumors and unconfirmed anecdotes on social media.

***

Sallie’s sisters and brothers in Orwood soon developed the same symptoms as Sallie. By September, 30-plus people in Taylor and Orwood showed signs of the disease and new cases were reported outside the local area. In response, three interstate railroads shut down and Memphis halted train traffic coming into the city. In Starkville, the president of Mississippi A&M (now Mississippi State University) posted a column of guards along its roads. In mid-October, officials placed all of Mississippi under quarantine as thousands fled the state.

Months earlier, the governor of Mississippi, recognizing the heavy toll yellow fever often brought to his state, had sent a team of Board of Health physicians to Cuba, the center for yellow fever research. There the group met with Dr. Walter Reed, the Army physician directing the American research interests on the island. Reed pursued a theory that mosquitos transmitted the disease, but his experiments to establish that link repeatedly failed. The Mississippi team, including Dr. Henry Gant, a Water Valley doctor, returned home, still hopeful that science could soon solve the yellow fever mystery.

Gant immediately responded when he learned about the outbreak in Taylor. So did Dr. Henry Rose Carter, a field epidemiologist who served as the quarantine officer at Ship Island and who investigated yellow fever outbreaks throughout the South.

Committed to the same rigorous scientific process that epidemiologists use today, Carter looked for patterns in how diseases spread within clusters of people. With yellow fever, he needed to identify the first person to develop the disease in a specific area and then trace everybody and everything that the person came into contact with.

Over and over again, unreliable sources or conflicting pieces of data prevented Carter from finding a pattern. People, suspicious of government intervention and scared of the consequences of yellow fever, often distorted the truth.

Fortunately for us today, the people of Orwood proved to be different. The people, Carter wrote, were “honest enough to tell the truth” and cooperated with efforts to trace the infection of each case.

Working with Carter, Gant moved from house to house in Orwood, instructing families to quarantine at home, though their natural inclination was to care for their neighbors. He also questioned each person, recording data for Gant’s analysis.

Unlike diseases that produce low-grade fevers, an abrupt and high fever often characterizes a case of yellow fever. For that reason, many of the people Gant interviewed reported the day their infections started and also the time their fevers ignited: Mr. G. W. McMillan, sickened on Aug. 29 at noon. Mrs. Rogers, Sept. 4, 10:00 am.

Collecting this detailed information about time proved essential for Carter’s study and he cheered Gant’s ability to gather such reliable data. “A greater tribute to the good faith of the community, or to its confidence in Dr. Gant, can scarcely be given,” he wrote.

Studying the Orwood data, Carter recognized a consistent time interval between cases, about two weeks between the first case and the development of secondary cases. This meant that the infection did not immediately spread from person-to-person but required time to incubate. He called this the period of extrinsic incubation.

I’ve read Carter’s scientific report with the results of the Orwood study, the same report that persuaded Walter Reed to alter his experimental process. Waiting 10-14 days before introducing infected mosquitos to healthy volunteers, Reed successfully demonstrated the transmission of yellow fever from mosquito to human.

With the development of mosquito control procedures, the fever soon vanished in the U.S. and Caribbean. Today a vaccine can protect those travelling or living where the disease remains a threat.

***

Sallie and her siblings were among the lucky, surviving their infections with only lingering weakness and fatigue. When frosts fell in north Mississippi in early November 1898, the number of fever cases quickly fell. In total, officials confirmed 2,478 cases across the state. Those who died totaled 114.

Reed later acknowledged that the “work in Mississippi did more to impress me with the importance of an intermediate host in yellow fever than everything else put together.”

***

My husband and I drove from our home in Oxford to Taylor and then Orwood on a hot muggy day in August, probably experiencing the same weather conditions as Sallie. Orwood is a ghost town today, but we found the cemetery where Sallie’s uncle is buried, adjacent to the wood-planked Presbyterian Church that still stands.

Walking those grounds emphasized for me what the neighbors who once lived in Orwood taught us. Honesty and rigorous scientific inquiry — and not political rhetoric or unproven claims — are the tools we must trust to combat disease and dispel fear.

Bio: Shirley Wimbish Gray lives in Oxford. A retired writing instructor and science editor, she writes about what is often overlooked or forgotten, particularly in the American South. Her recent essays have appeared in Earth Island, Brevity Blog and Persimmon Tree.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Ghost town of Orwood residents provide lessons for today by working with scientists in 1800s to combat yellow fever appeared first on mississippitoday.org

Political Bias Rating: Centrist

This article does not present a clear ideological stance but rather focuses on a historical account of a yellow fever outbreak in 1898 and its connection to scientific advancements. The content emphasizes the importance of honesty, scientific inquiry, and collaboration, contrasting it with political rhetoric and unproven claims. The mention of contemporary issues, like Mississippi’s falling childhood vaccination rates and recent policy changes affecting medical research, introduces a subtle critique of current trends in public health. However, the tone remains balanced, and the piece refrains from offering a partisan viewpoint, focusing instead on lessons learned from history and the value of scientific rigor. The discussion of current events is presented more as a concern for public health rather than a partisan critique.

Mississippi Today

On this day in 1964, Klan killed Henry Dee and Charles Moore

Published

2 days ago

May 2, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-05-02 07:00:00

by Jerry Mitchell, Mississippi Today
May 2, 2025

May 2, 1964

Thomas Moore is holding a 1964 photograph of him and his younger brother, Charles, shortly before his brother was kidnapped and killed by Klansmen, along with Henry Hezekiah Dee.

Henry Hezekiah Dee and Charles Eddie Moore, two 19-year-old Black Americans, were simply trying to get a ride back home. Instead, Klansmen abducted them, took them to the Homochitto National Forest, where they beat the pair and then drowned them in the Mississippi River.

When their bodies were found in an old part of the river, FBI agents initially thought they had found the bodies of three missing civil rights workers, James Chaney, Andrew Goodman and Michael Schwerner.

Thanks to the work of Moore’s brother, Thomas, and Canadian filmmaker David Ridgen, federal authorities reopened the case in 2005. Two years later, a federal jury convicted James Ford Seale. He received three life sentences and died in prison.

Ridgen did a podcast on the case for the CBC series, “Somebody Knows Something.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post On this day in 1964, Klan killed Henry Dee and Charles Moore appeared first on mississippitoday.org

Political Bias Rating: Centrist

This article presents historical facts about the 1964 kidnapping and murder of two Black Americans by Klansmen. It provides an account of the tragic event, recounting the abduction, the subsequent investigation, and the eventual conviction of one of the perpetrators. The article sticks to reporting the details of the case, including the efforts of Thomas Moore and filmmaker David Ridgen to reopen the case and bring justice. While the subject matter is deeply tied to civil rights, the tone of the article remains neutral, focusing on factual events without pushing a particular ideological stance. The language used is factual and matter-of-fact, presenting the events as they happened rather than offering opinion or judgment, making the content centrist in its approach.